|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.24 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: BCBS Trust/PPO |
$152.26
|
| Rate for Payer: BCBS Trust/PPO |
$170.50
|
| Rate for Payer: BCN Commercial |
$144.15
|
| Rate for Payer: BCN Commercial |
$161.41
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$179.63
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$152.95
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$177.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health HMO/PPO |
$181.72
|
| Rate for Payer: Priority Health HMO/PPO |
$162.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.81
|
| Rate for Payer: UHC Core |
$155.75
|
| Rate for Payer: UHC Core |
$174.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.65
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.24 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: BCBS Trust/PPO |
$152.26
|
| Rate for Payer: BCN Commercial |
$144.15
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Nomi Health Commercial |
$152.95
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health HMO/PPO |
$162.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.15
|
| Rate for Payer: UHC Core |
$155.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.29
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: BCBS MAPPO |
$46.63
|
| Rate for Payer: BCBS Trust/PPO |
$153.35
|
| Rate for Payer: BCN Commercial |
$145.03
|
| Rate for Payer: BCN Medicare Advantage |
$46.63
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.63
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Nomi Health Commercial |
$152.95
|
| Rate for Payer: PACE Senior Care Partners |
$44.30
|
| Rate for Payer: PACE SWMI |
$46.63
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: PHP Medicare Advantage |
$46.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health HMO/PPO |
$162.28
|
| Rate for Payer: Priority Health Medicare |
$47.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.98
|
| Rate for Payer: Railroad Medicare Medicare |
$46.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.15
|
| Rate for Payer: UHC Core |
$155.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.63
|
| Rate for Payer: UHC Exchange |
$46.63
|
| Rate for Payer: UHC Medicare Advantage |
$46.63
|
| Rate for Payer: VA VA |
$46.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.23
|
|
|
Service Code
|
NDC 51672207502
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare |
$2.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.20
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: BCBS MAPPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.41
|
| Rate for Payer: BCN Commercial |
$7.95
|
| Rate for Payer: BCN Medicare Advantage |
$2.56
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.56
|
| Rate for Payer: Healthscope Commercial |
$9.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.70
|
| Rate for Payer: Nomi Health Commercial |
$8.39
|
| Rate for Payer: PACE Senior Care Partners |
$2.43
|
| Rate for Payer: PACE SWMI |
$2.56
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: PHP Medicare Advantage |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.65
|
| Rate for Payer: Priority Health HMO/PPO |
$8.90
|
| Rate for Payer: Priority Health Medicare |
$2.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.85
|
| Rate for Payer: Railroad Medicare Medicare |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.00
|
| Rate for Payer: UHC Core |
$8.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicare Advantage |
$2.56
|
| Rate for Payer: VA VA |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
NDC 14428000944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$6.32
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$12.99
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: PACE Senior Care Partners |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health Medicare |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Exchange |
$3.95
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: VA VA |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
NDC 00536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.08
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Nomi Health Commercial |
$8.58
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health HMO/PPO |
$9.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.20
|
| Rate for Payer: UHC Core |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
NDC 14428000944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: BCBS Trust/PPO |
$12.90
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$63.97
|
|
|
Service Code
|
NDC 16784011761
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna Commercial |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$52.22
|
| Rate for Payer: BCN Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$55.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.18
|
| Rate for Payer: Healthscope Commercial |
$57.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.37
|
| Rate for Payer: Nomi Health Commercial |
$52.46
|
| Rate for Payer: PHP Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.58
|
| Rate for Payer: Priority Health HMO/PPO |
$55.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.29
|
| Rate for Payer: UHC Core |
$53.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.98
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
NDC 00536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$2.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.27
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS MAPPO |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: BCN Commercial |
$8.13
|
| Rate for Payer: BCN Medicare Advantage |
$2.62
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Nomi Health Commercial |
$8.58
|
| Rate for Payer: PACE Senior Care Partners |
$2.48
|
| Rate for Payer: PACE SWMI |
$2.62
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: PHP Medicare Advantage |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.80
|
| Rate for Payer: Priority Health HMO/PPO |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$2.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.01
|
| Rate for Payer: Railroad Medicare Medicare |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.20
|
| Rate for Payer: UHC Core |
$8.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.62
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicare Advantage |
$2.62
|
| Rate for Payer: VA VA |
$2.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.23
|
|
|
Service Code
|
NDC 51672207502
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: BCBS Trust/PPO |
$8.35
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.70
|
| Rate for Payer: Nomi Health Commercial |
$8.39
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.65
|
| Rate for Payer: Priority Health HMO/PPO |
$8.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.00
|
| Rate for Payer: UHC Core |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$63.97
|
|
|
Service Code
|
NDC 16784011761
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna Commercial |
$54.37
|
| Rate for Payer: Aetna Medicare |
$16.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.99
|
| Rate for Payer: BCBS Complete |
$25.59
|
| Rate for Payer: BCBS MAPPO |
$15.99
|
| Rate for Payer: BCBS Trust/PPO |
$52.59
|
| Rate for Payer: BCN Commercial |
$49.74
|
| Rate for Payer: BCN Medicare Advantage |
$15.99
|
| Rate for Payer: Cash Price |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$55.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$57.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.37
|
| Rate for Payer: Nomi Health Commercial |
$52.46
|
| Rate for Payer: PACE Senior Care Partners |
$15.19
|
| Rate for Payer: PACE SWMI |
$15.99
|
| Rate for Payer: PHP Commercial |
$54.37
|
| Rate for Payer: PHP Medicare Advantage |
$15.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.58
|
| Rate for Payer: Priority Health HMO/PPO |
$55.65
|
| Rate for Payer: Priority Health Medicare |
$16.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.86
|
| Rate for Payer: Railroad Medicare Medicare |
$15.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.29
|
| Rate for Payer: UHC Core |
$53.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.99
|
| Rate for Payer: UHC Exchange |
$15.99
|
| Rate for Payer: UHC Medicare Advantage |
$15.99
|
| Rate for Payer: VA VA |
$15.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.98
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 00172409660
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: BCBS Trust/PPO |
$145.79
|
| Rate for Payer: BCN Commercial |
$138.02
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$146.45
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.09
|
| Rate for Payer: Priority Health HMO/PPO |
$155.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.17
|
| Rate for Payer: UHC Core |
$149.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 00172409660
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$46.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.81
|
| Rate for Payer: BCBS Complete |
$71.44
|
| Rate for Payer: BCBS MAPPO |
$44.65
|
| Rate for Payer: BCBS Trust/PPO |
$146.83
|
| Rate for Payer: BCN Commercial |
$138.86
|
| Rate for Payer: BCN Medicare Advantage |
$44.65
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.65
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$146.45
|
| Rate for Payer: PACE Senior Care Partners |
$42.42
|
| Rate for Payer: PACE SWMI |
$44.65
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: PHP Medicare Advantage |
$44.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.09
|
| Rate for Payer: Priority Health HMO/PPO |
$155.38
|
| Rate for Payer: Priority Health Medicare |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.66
|
| Rate for Payer: Railroad Medicare Medicare |
$44.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.17
|
| Rate for Payer: UHC Core |
$149.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.65
|
| Rate for Payer: UHC Exchange |
$44.65
|
| Rate for Payer: UHC Medicare Advantage |
$44.65
|
| Rate for Payer: VA VA |
$44.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 52817032010
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: BCBS Trust/PPO |
$107.43
|
| Rate for Payer: BCN Commercial |
$101.70
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health HMO/PPO |
$114.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.81
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$341.05
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$306.94 |
| Rate for Payer: Aetna Commercial |
$289.89
|
| Rate for Payer: Aetna Medicare |
$88.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.58
|
| Rate for Payer: BCBS Complete |
$136.42
|
| Rate for Payer: BCBS MAPPO |
$85.26
|
| Rate for Payer: BCBS Trust/PPO |
$280.38
|
| Rate for Payer: BCN Commercial |
$265.17
|
| Rate for Payer: BCN Medicare Advantage |
$85.26
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.26
|
| Rate for Payer: Healthscope Commercial |
$306.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.89
|
| Rate for Payer: Nomi Health Commercial |
$279.66
|
| Rate for Payer: PACE Senior Care Partners |
$81.00
|
| Rate for Payer: PACE SWMI |
$85.26
|
| Rate for Payer: PHP Commercial |
$289.89
|
| Rate for Payer: PHP Medicare Advantage |
$85.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.68
|
| Rate for Payer: Priority Health HMO/PPO |
$296.71
|
| Rate for Payer: Priority Health Medicare |
$86.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.50
|
| Rate for Payer: Railroad Medicare Medicare |
$85.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.12
|
| Rate for Payer: UHC Core |
$284.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.26
|
| Rate for Payer: UHC Exchange |
$85.26
|
| Rate for Payer: UHC Medicare Advantage |
$85.26
|
| Rate for Payer: VA VA |
$85.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.79
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$341.05
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$306.94 |
| Rate for Payer: Aetna Commercial |
$289.89
|
| Rate for Payer: BCBS Trust/PPO |
$278.40
|
| Rate for Payer: BCN Commercial |
$263.56
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$306.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.89
|
| Rate for Payer: Nomi Health Commercial |
$279.66
|
| Rate for Payer: PHP Commercial |
$289.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.68
|
| Rate for Payer: Priority Health HMO/PPO |
$296.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.12
|
| Rate for Payer: UHC Core |
$284.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.79
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 52817032010
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.26 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$34.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.12
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: BCBS MAPPO |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$108.19
|
| Rate for Payer: BCN Commercial |
$102.32
|
| Rate for Payer: BCN Medicare Advantage |
$32.90
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: PACE Senior Care Partners |
$31.26
|
| Rate for Payer: PACE SWMI |
$32.90
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: PHP Medicare Advantage |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health HMO/PPO |
$114.49
|
| Rate for Payer: Priority Health Medicare |
$33.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.17
|
| Rate for Payer: Railroad Medicare Medicare |
$32.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.81
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.90
|
| Rate for Payer: UHC Exchange |
$32.90
|
| Rate for Payer: UHC Medicare Advantage |
$32.90
|
| Rate for Payer: VA VA |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 52817031910
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: BCBS Trust/PPO |
$268.56
|
| Rate for Payer: BCN Commercial |
$254.25
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 52817031910
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna Medicare |
$85.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.81
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: BCBS MAPPO |
$82.25
|
| Rate for Payer: BCBS Trust/PPO |
$270.47
|
| Rate for Payer: BCN Commercial |
$255.80
|
| Rate for Payer: BCN Medicare Advantage |
$82.25
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.25
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: PACE Senior Care Partners |
$78.14
|
| Rate for Payer: PACE SWMI |
$82.25
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: PHP Medicare Advantage |
$82.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Medicare |
$83.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.43
|
| Rate for Payer: Railroad Medicare Medicare |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.25
|
| Rate for Payer: UHC Exchange |
$82.25
|
| Rate for Payer: UHC Medicare Advantage |
$82.25
|
| Rate for Payer: VA VA |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 72888000901
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.23 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$54.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.09
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: BCBS MAPPO |
$52.88
|
| Rate for Payer: BCBS Trust/PPO |
$173.87
|
| Rate for Payer: BCN Commercial |
$164.44
|
| Rate for Payer: BCN Medicare Advantage |
$52.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.88
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Nomi Health Commercial |
$173.43
|
| Rate for Payer: PACE Senior Care Partners |
$50.23
|
| Rate for Payer: PACE SWMI |
$52.88
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: PHP Medicare Advantage |
$52.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.48
|
| Rate for Payer: Priority Health HMO/PPO |
$184.00
|
| Rate for Payer: Priority Health Medicare |
$53.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.70
|
| Rate for Payer: Railroad Medicare Medicare |
$52.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.12
|
| Rate for Payer: UHC Core |
$176.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.88
|
| Rate for Payer: UHC Exchange |
$52.88
|
| Rate for Payer: UHC Medicare Advantage |
$52.88
|
| Rate for Payer: VA VA |
$52.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 72888000901
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.48 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: BCBS Trust/PPO |
$172.65
|
| Rate for Payer: BCN Commercial |
$163.45
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Nomi Health Commercial |
$173.43
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.48
|
| Rate for Payer: Priority Health HMO/PPO |
$184.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.12
|
| Rate for Payer: UHC Core |
$176.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
OP
|
$188.37
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.74 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Aetna Commercial |
$160.11
|
| Rate for Payer: Aetna Medicare |
$48.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.87
|
| Rate for Payer: BCBS Complete |
$75.35
|
| Rate for Payer: BCBS MAPPO |
$47.09
|
| Rate for Payer: BCBS Trust/PPO |
$154.86
|
| Rate for Payer: BCN Commercial |
$146.46
|
| Rate for Payer: BCN Medicare Advantage |
$47.09
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cofinity Commercial |
$162.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.09
|
| Rate for Payer: Healthscope Commercial |
$169.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.11
|
| Rate for Payer: Nomi Health Commercial |
$154.46
|
| Rate for Payer: PACE Senior Care Partners |
$44.74
|
| Rate for Payer: PACE SWMI |
$47.09
|
| Rate for Payer: PHP Commercial |
$160.11
|
| Rate for Payer: PHP Medicare Advantage |
$47.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.44
|
| Rate for Payer: Priority Health HMO/PPO |
$163.88
|
| Rate for Payer: Priority Health Medicare |
$47.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.21
|
| Rate for Payer: Railroad Medicare Medicare |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.77
|
| Rate for Payer: UHC Core |
$157.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.09
|
| Rate for Payer: UHC Exchange |
$47.09
|
| Rate for Payer: UHC Medicare Advantage |
$47.09
|
| Rate for Payer: VA VA |
$47.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.28
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$188.37
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.44 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Aetna Commercial |
$160.11
|
| Rate for Payer: BCBS Trust/PPO |
$153.77
|
| Rate for Payer: BCN Commercial |
$145.57
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cofinity Commercial |
$162.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.70
|
| Rate for Payer: Healthscope Commercial |
$169.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.11
|
| Rate for Payer: Nomi Health Commercial |
$154.46
|
| Rate for Payer: PHP Commercial |
$160.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.44
|
| Rate for Payer: Priority Health HMO/PPO |
$163.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.77
|
| Rate for Payer: UHC Core |
$157.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.28
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.25
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS MAPPO |
$37.00
|
| Rate for Payer: BCBS Trust/PPO |
$121.67
|
| Rate for Payer: BCN Commercial |
$115.07
|
| Rate for Payer: BCN Medicare Advantage |
$37.00
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.00
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: PACE Senior Care Partners |
$35.15
|
| Rate for Payer: PACE SWMI |
$37.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: PHP Medicare Advantage |
$37.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Medicare |
$37.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.16
|
| Rate for Payer: Railroad Medicare Medicare |
$37.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.00
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$37.00
|
| Rate for Payer: VA VA |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: BCBS Trust/PPO |
$120.81
|
| Rate for Payer: BCN Commercial |
$114.37
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
